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Give Me Your Tired, Your Poor...Your Eyes, That Is

By Mark Mattison-Shupnick, ABOM

Release Date: July 2011

Expiration Date: August 30, 2012

Learning Objectives:

Upon completion of this program, the participant should be able to:

  1. Define accommodation and the ways accommodation is overtaxed today.
  2. Understand the telltale signs of visual fatigue.
  3. Learn how a small amount of plus power (+0.65D), added to the lower portion of a lens, can reduce visual fatigue for patients ages 18 to 38.
  4. Understand how this new lens can be described and recommended for any single vision patient complaining of visual fatigue.

Faculty/Editorial Board:

Mark Mattison-Shupnick Mark Mattison-Shupnick, ABOM, FNAO is currently director of education and training, program development for Jobson Information Services LLC, has more than 35 years of experience as an optician, was senior staff member of SOLA International and is a frequent lecturer and trainer.

Credit Statement:

This course is approved for one (1) hour of CE credit by the American Board of Opticianry (ABO). Course STJMI080-1

Calling all Millennials and Generation X-ers from 18 to 38 years old. Visit your eyecare professional tomorrow and an optician will help you with your tired eyes. You know who you are: You just finished an all-nighter studying for an exam; you were in a texting duel while completing 27 successive tweets and simultaneously watched three of the most popular YouTube videos while playing “Toon Warz” and “Speed Forge 3D” on your smartphone. Your eyes must be very tired. Relax, we've got a solution.

Every day, every hour, emmetropes and single vision prescription wearers put a lot of demand and natural stress on their eyes. That's because we live in a “mediacentric” world, where the devices that we spend so much time consulting and socializing with, place a new and significant demand on accommodation. It's often taxed to the max.

Sure there are lots of accommodative solutions for presbyopes, but what about single-vision (SV) wearers? Introducing Relax, the new single-vision, free-form design from Shamir, crafted specifically to relieve visual fatigue.


In today's high-tech world the eyes are constantly focusing on PDAs, laptops, e-readers, tablets and cell phone text messages. Focusing on close and mid-range objects, or small letters and images on small screens is an effort for the eyes. Especially when combined with long work hours, this prolonged accommodative effort often leads to tiredness, tearing, headache and blurry vision. Why?

Human eyes are at the peak of their accommodative capabilities around the age of 9, after which there is a gradual decline with the passing years. During ages 18 to 27, many are spending countless hours reading, researching and writing for college. By ages 28 to 38, accommodation can have a noticeable lag and can be difficult to sustain for long hours of intermediate and close vision tasks. Even if visual correction for close viewing is not required, the eyes need a solution for the eyestrain created by tasks at this everyday range of mid and near vision.


Most people who are “connected” electronically spend 60 percent of their time in the zone—intermediate and near. They suffer visual fatigue and probably recognize its symptoms as eyestrain, but do little to make it better.

Part of the problem is that it's a changing environment at near and mid-range. Today, about 40 percent of all cell phones are smartphones, and more than 92 percent of the 18 to 38 age group owns a cell phone. Smartphone penetration i.e., those with video, app and gaming features is expected to overtake ordinary feature phones by the end of the third quarter of 2011. In addition, about 27 percent of the U.S. population or about 83 million people are in this age group. Adding all this up results in the following observations: 1. Visual demand at intermediate and near is going to increase. 2. A significant part of the population is in this problem age group, and 3. Accommodative fatigue affects both prescription and non-prescription wearers. This means real opportunities if you have the right solution.

In addition, the reliance on mobile devices will continue to increase. For example, by 2020 most people will connect to remote server networks like cloud computing rather than personal computers. That means the screen will often be handheld and vary in the distance being viewed. Today, 500 million people use Facebook; that's being social in the cloud. Other examples are Hotmail and Yahoo mail, Twitter and WordPress and video sharing sites like YouTube. Want an opinion shared from the cloud? Visit Yelp and TripAdvisor. Therefore, there's a significant opportunity for vision problems for people, and an opportunity to deliver solutions for the ECP.


Reading, but more importantly the arm's length world we live in online, taxes the accommodative mechanism. Accommodation is the eye's ability to adjust lens shape to produce a crisp, well-focused image on the retina. As we said, the 28 to 38 age group, depending on prescription and personal vision traits begins to “see” the effects of reduced accommodative ability.

As we age, we lose the art of accommodation. But Relax lenses are aimed at more than the pre-presbyope. In pre-presbyopia (38 to 42), focusing from distance or near and back slows down, making this age group aware that something is happening. It's easier to recognize the effect by the difficulty of focusing on a menu in a dimly-lit restaurant. Focus and the loss of depth of field from a larger pupil combine to make difficulty focusing noticeable.

Of course, comfort and accuracy on any of the gadgets described depends also on screen size, font size and shape. The various software companies have spent considerable time developing the right fonts to improve visibility. But no matter what they do, watching a movie on your iPhone and playing games on that Droid for extended periods of time strains the accommodative system. From Pew Research, 18- to 38-year-olds have more mobile devices and own three to four of the variety of devices that are available. Why does this size add to visual fatigue?

First, standard screens on mobile devices and laptops create letters and graphic images at what appears to be different depth relative to the surface of the screen. That causes the eye to shift focus back and forth between the surface and the apparent position of the image. The result is that the eye is always shifting focus, and this accounts for the visual fatigue that most computer users experience.

Next for some younger patients, they may have a “lag of accommodation,” i.e., eyes that fail to focus (accommodate) accurately for the distance needed. The average lag, described in optometric texts, is about 0.75D. It could be due to uncorrected hyperopia or may indicate accommodative insufficiency. Most young people with this situation may go undetected without having a comprehensive eye exam but would benefit from a small amount of plus to assist when needed.

Enter 3D—on cell phones, laptops, TVs and in the movies. Again, the depth of perceived image changes from on screen to both before and behind the screen creates an effect called “vergence-accommodation conflict.” This is an important effect and 3D producers pay close attention to this for comfortable and restful viewing. Not everyone will be using 3D all the time, but it will be a part of the mix of gadgets and routines that will continue to contribute to visual fatigue.

With displays of smartphones at about 3.5 inches (all four iPhone versions have a 3.5 inch screen measured diagonally), and the shift to video availability, better image quality drove technological invention. Now that it is possible, more people will be watching on small screens but screen size hasn't increased enough to reduce potential fatigue. It seems that even though a larger screen would help, purchasers buy smaller. The advantages of a larger screen seem to give way to the software and carrier's marketing.

It's clear that gadgets and small images can stress accommodation. The result is “overwork” and strain to hold focus.


Simply stated, a lens that is designed to automatically relieve accommodative demand would be an advantage. By adding a pinch of plus to the lower portion of the lens, reading and midrange demand is reduced. As a result, closer tasks seem easier and there is less effort to sustain clear vision. That means one can work at these distances visually stressfree for longer periods of time.

Consider the following analogy—myopes and new contact lenses. When myopes go to contact lenses during that mid-life crisis (early 40s), they uncover an immediate need for reading glasses. That's because with contact lenses they no longer get the benefit of the base in prism from their spectacle lenses. Base in prism reduces convergence and therefore the amount of accommodation needed. The suggestion here is to add a small amount of plus to the right place in a spectacle lens and make reading and mid-range tasks easier. The result becomes an invisible aid to everyday comfort regardless of how much demand there is for sustained reading and mid-range vision.

This small amount of plus can also correct the lag that some patients experience. Having extra plus available removes the awareness of a lag.


Shamir Relax is a new lens designed to replace single-vision lenses. The lens acts like single-vision but the lower portion of the lens incorporates a shift to a +0.65D plus power.

The design is a clever use of free-form technology. The prescription for the single-vision design is combined with a +0.65D progression in the lower portion of the lens. This is not the typical progressive as you know it. Free-form cutting and techniques organize this plus power with the Rx, frame dimensions, and patient PD and fitting height.

You may want to understand how long the corridor is or if there is any blur or fitting requirements. When this is free-form cut in the lab, the design gains power quickly, reaches 85 percent of the total power about 13 mm below the optical center (O.C.), and full power in another 2 mm.

If this is a progressive power lens, is there blur and where? We all have fitted low Add (+1.00D, +1.25D) lenses to new presbyopes. Rarely, if ever are there blur problems. The most astigmatism created in a new Relax lens is about 0.50D. That means the wearer will probably not notice any blur at all. We know from many companies' research that shows most progressive wearers do not notice or are not bothered by unwanted astigmatism until it reaches about 1D. Therefore, there is no need to worry.

The small Add helps with accommodation. For this age range it can reduce accommodative demand up to 30 percent for mid-range and near tasks. The design and small power change also ensure effortless adaptation. As a result, this can provide patients with renewed energy at the end of the day.


This lens is classified as a single-vision lens. It is used and recommended for patients that fit the 18 to 38 category, are heavy users of electronic gadgets and agree that their eyes feel tired at the end of the day. That of course suggests a comprehensive eye exam and a recommendation for lenses that help relieve the visual fatigue they feel daily.

Shamir Relax is available in a full range of powers through the Shamir network of Autograph partner laboratories. Choose from hard resin, polycarbonate and 1.6 high-index, clear and Transitions polarized and/or Drivewear to best meet patient needs and budgets.

However, there is an argument for thinner and lighter lenses. Since the advantage of this design is to reduce visual fatigue, it makes sense to also reduce lens volume (thinness) and lens weight to make that pair of glasses as light as possible all the time. Consult your lab for complete details.


Let's review the right target audience. Consider the 18 to 38 group as an overall category. Logically, pre-presbyopes are already seeing the effects of reduced accommodative ability. Some experience a lag of accommodation.

As we discussed, contact lens wearers are also a logical target for Shamir Relax lenses. When 9 degrees tilt Fit to pupil center 16mm minimum wearing contact lenses, myopes especially, converge more and have more accommodative demand so they would benefit from Relax.

Some practitioners may also consider these lenses for lag of accommodation in teens. If this occurs they may have difficulty reading because they cannot sustain the same accommodative effort for long periods of time. A small plus Add can relieve the problem.


“Do you have tired eyes, headaches, blurred vision or neck and shoulder pain at the end of the day?” Asking questions like this reaffirms that the patient would like your help. When the patient says, “Yes please,” tell them, “Relax, I can help you with that, here's how.” (This assumes that the prescription the patient is wearing is correct.) When?

First, reception is the best time to begin the assessment of why a patient is visiting and an opportunity to define the benefits with which they can leave. Next during pre-testing, uncover comments about visual fatigue. In the exam room, a clear set of questions and testing can confirm the need and therefore the solution. Be sure to describe these recommendations during the hand-off to the optician. This puts the optician in the know, and continues the discussion for fitting visual fatigue lenses.

If you think this makes sense for you and your office, set goals, record sales and measure your success.


Before taking fitting measurements, adjust the frame. Pantoscopic tilt should be about 9 degrees with a small amount of face form (wrap).

Like other single-vision lenses, Relax lenses are fitted using monocular PDs. Then measure fitting height at pupil center and ensure that there is a minimum fitting height of 16 mm. Of course, any digital camera measuring system and/or a Shamir Panorameter will provide excellent measurements.

When dispensing, demonstrate the effect of the small plus power in the lower portion of the lens.


Are you changing the Rx by adding an addition to a SV lens?

It's a good idea to discuss these lenses with the prescribing doctor and have your results added to the patient's record. Sending an e-mail to the prescriber listing the frame, lens and fitting parameters would do the trick. It also pre-empts the problem when a patient returns to the prescriber to have the lens verified, and the office doesn't understand the lens that was dispensed.


Just a few words about those other folks. They are candidates also. This lens can be used for a mid-range and reading lens. Again, Dr. Wan suggests that an SV intermediate power lens with a +0.65D Add can make for a useful lens at the computer.


Tell your patients, “Consult and socialize online as much as you want. Relax, your vision that is, with these new lenses.” Relax is a new free-form lens design from Shamir specially crafted to relieve visual fatigue in the single-vision lens wearer. Add these lenses to your toolbox and address an opportunity that will make a difference in your practice tomorrow. Get all the materials needed from your lab and get started today.

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